Publisher: Dove Press
Journal: Clinical Ophthalmology
Subjects: ocular myasthenia, blepharoplasty, RE1-994, Clinical Ophthalmology, ptosis, myasthenia gravis, Original Research, Ophthalmology
Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis. Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients. Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period. Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and discuss comprehensive treatment plans to increase the quality of life for patients with myasthenia gravis.Keywords: ptosis, myasthenia gravis, ocular myasthenia, blepharoplasty
The results below are discovered through our pilot algorithms. Let us know how we are doing!
- 1. Kapetansky DI. Surgical correction of blepharoptosis in myasthenia gravis. Am J Ophthalmol. 1972;74(5):818-820.
- 2. Bradley EA, Bartley GB, Chapman KL, Waller RR. Surgical correction of blepharoptosis in patients with myasthenia gravis. Ophthal Plast Reconstr Surg. 2001;17(2):103-110.
- 3. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. 1996;103(4):623-630.
- 4. Yu CC, Chen SG, Chen TM. Frontalis slings with palmaris tendon as an adjuvant treatment for myasthenic blepharoptosis: a case report. Ann Plast Surg. 2007;58(5):577-579.
- 5. Asamura S, Kakizaki H, Enjyo M, Hashimoto T, Isogai N. Frontalis sling procedure for ocular myasthenia gravis. Clin Ophthalmol. 2012; 6:575-577.
- 6. Benatar M, Kaminski H. Medical and surgical treatment for ocular myasthenia. Cochrane Database Syst Rev. 2012;12:CD005081.
- 7. Bever CT Jr, Aquino AV, Penn AS, Lovelace RE, Rowland LP. Prognosis of ocular myasthenia. Ann Neurol. 1983;14(5):516-519.
- 8. Oosterhuis HJGH. Myasthenia Gravis. Groningen: Groningen Neurologic Press; 1997.
- 9. Benatar M, Kaminski HJ; Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;68(24):2144-2149.
- 10. Osserman KE. Ocular myasthenia gravis. Invest Ophthalmol. 1967; 6(3):277-287.
- 11. Sghirlanzoni A, Peluchetti D, Mantegazza R, Fiacchino F, Cornelio F. Myasthenia gravis: prolonged treatment with steroids. Neurology. 1984;34(2):170-174.
- 12. Evoli A, Batocchi AP, Minisci C, Di Schino C, Tonali P. Therapeutic options in ocular myasthenia gravis. Neuromuscul Disord. 2011;11(2):208-216.
- 13. Kaminski HJ, Daroff RB. Treatment of ocular myasthenia: steroids only when compelled. Arch Neurol. 2000;57(5):752-753.
- 14. Roach ES. Treating ocular Myasthenia Gravis with inadequate evidence. Arch Neurol. 2007;64(12):1794-1795.
- 15. Nagane Y, Utsugisawa K, Suzuki S, et al. Topical naphazoline in the treatment of myasthenic blepharoptosis. Muscle Nerve. 2011;44(1):41-44.
- 16. Shimizu Y, Suzuki S, Utsugisawa K, et al. Is surgical intervention safe and effective in the treatment of myasthenic blepharoptosis? A multicenter survey in Japan. Eur Neurol. 2014;71(5-6):259-261.
- 17. Carraway JH, Vincent MP. Levator advancement technique for eyelid ptosis. Plast Reconstr Surg. 1986;77(3):394-403.
- 18. Shimizu Y, Nagasao T, Asou T. A new non-incisional correction method for blepharoptosis. J Plast Reconstr Aesthet Surg. 2010;63(12): 2004-2012.
- 19. Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology. 2000;55(1):16-23.
- 20. Paul RH, Nash JM, Cohen RA, Gilchrist JM, Goldstein JM. Quality of life and well-being of patients with myasthenia gravis. Muscle Nerve. 2011;24(4):512-516.
- 21. Mullins LL, Carpentier MY, Paul RH, Sanders DB; Muscle Study Group. Disease-specicfi measure of quality of life for myasthenia gravis. Muscle Nerve. 2008;38(2):947-956.
- 22. Masuda M, Utsugisawa K, Suzuki S, et al. The MG-QOL15 Japanese version: validation and associations with clinical factors. Muscle Nerve. 2012;46(2):166-173.
- 23. Lacomis D, Silvestri NJ, Wolfe GI. What's in the Literature? J Clin Neuromuscul Dis. 2014;16(1):32-41.
No related research data.
No similar publications.